Fracture reducing table



May 4, 1937., R. ANDERSON FRACTURE REDUCING TABLE .Filed Aug. 22, 1932 4 Sheets-Sheet l INVENToR 7:3065@ @Vo/Q6 U/Y BY Y May 4, 1937. R. ANDERSON FRACTURE REDUCING TABLE' Filed Aug. 22, 1952 4 Sheets-Sheet 2 ATTORNEY My 4, 1937. R. ANDERSON FRACTURE REDUCING ATABLE Filed Aug. 22, I195.2 4 sheets-sheet s INVENToR P0765@ #Naf/95m Malyl 4, 1937. R. ANDERSON FRACTURE REDUCING TABLE Filed Aug. 22], 1952 4` sheets-smet 4 INVENTOR ATrQRNEY Patented May 4, 1937 UNITED STATES PATENT OFFICE FRACTURE REDUCING TABLE of Washington Application August 2.2,

Claims.

This invention relates to apparatus for the reduction of fractures. More particularly it is designed for the reduction of fractures occurring in bones of the pelvis or in a leg of the human body, and in its application it is contemplated that the uninjured limb shall be used as a means through which a tractive force may be applied to the injured limb for the reduction of the fracture; the present device being in the nature of a modication or improvement upon the device disclosed and illustrated in my pending application for patent, filed October 12, 1931, under Serial Number 568,321 which has matured into Patent No. 1,928,658.

The device of the above mentioned pending application employs an anchor stirrup, designed to be iixedly secured to the uninjured limb, and a yoke adapted to be attached for skeletal traction to a bone of the injured limb; these two parts having a connecting lever through which an adjustable pull or traction may be applied to the fractured member to draw and retain the injured limb properly in place for reduction of the fracture.

While there are many desirable features in the device of the above pending application, there are also certain disadvantages incident to its use. For example, it requires the application of plaster casts to both limbs of the patient and such casts must be skillfully applied. Furthermore, the device is not adapted to the easy treatment of compound fractures for the reason that the casts, which necessarily must be applied, prevent a satisfactory treatment and care of lacerations, joint infections, or the like.

In order to overcome the undesirable features above mentioned, it has been the principal object of the present invention to provide a device which is used in substantially the same manner and for the same purposes, but which does not require the application of plaster casts; which is more easily and readily applied; which is highly adjustable to take care of all deformities and which has various other advantages, with respect to treatment of the patient and pertaining to adjustment and reversibility of parts to adapt it to persons of different size or to either right or left leg reductions.

More specifically stated, the present invention resides in the provision of a device especially useful for reduction of intra-capsular, extra-capsular, intertrochanteric and pelvic fractures, as well as for fractures of the femur and bones of the lower leg. Also, a device for use in the treatment or correction of dislocations, open reductions,

1932, Serial N0. 629,926

(Cl. 12S-85) malunions, scoliosis, nonunion and congenital dislocations.

Briefly, the invention resides in the provision of a base plate equipped with separate means for connection with the legs of the injured person and which are relatively adjustable for the purpose of applying through the pelvis, a skeletal tractive force to the injured limb for reduction of the fracture. Also, the invention provides for a reversal of the attaching parts to accommodate the device to either right or left leg fractures, and it provides for required adjustments to adapt it to persons of different size.

It is also an object of the present invention to provide, in connection with the fracture reducing equipment, a detachable body supporting frame to aid in the applying of a spine cast, or to act as a fracture traction table or to permit of easy moving about of the injured person.

Other objects of the invention reside in the various details of construction, the combination of parts and their mode of operation, as will hereinafter be more fully described.

In acomplishing these and other objects of the invention, I have provided the improved details of construction, the preferred forms of which are illustrated in the accompanying drawings, wherein- Fig. 1 is a plan view of the device, illustrating its application to the lower limbs of an injured person for the reduction of a fracture of the left femur.

Fig. 2 is an elevation, partly in cross section, of one of the yokes embodied in the support used for the attachment of the uninjured limb to the base member of the device.

Fig. 3 is a sectional detail illustrating part of the means for effecting an adjustment of the support for the uninjured leg.

Fig. 4 is an elevation, partly in section, oi the traction yoke through which skeletal attachment is made to the injured limb; showing also its attachment to the base.

Fig. 5 is a detail illustrating the wire tightening means and pin clamp associated with the yoke of Fig. 4.

Fig. 5a is a detail of one of the base lugs.

Fig. 6 is an enlarged plan view of the well leg equipment as applied to a patient in use of the device.

Fig. 7 is a side elevation of the parts shown in Fig. 6; the base member being in section to better illustrate the means provided for adjusting the leg supporting equipment.

Fig. 8 is. a plan View of the injured leg equipment.

Fig. 9 is a side elevation of the same.

Fig. 10 is a plan view illustrating the fracture reducing or orthopedic table with the body transporting frame applied thereto.

Fig. 11 is a side elevation of the parts illustrated in Fig. 10, together with additional equipment.

Fig. 12 is a detail illustrating, in plan View, the joint in the frame structure.

IFig. 13 is a side view of the parts seen in Fig. 12.

Fig. 14 is a detail of a frame mounting socket.

Fig. l5 illustrates an alternative means for effecting adjustment of the base sections.

Referring more in detail to the drawings- In a preferred form of construction, the invention comprises a horizontal base structure, preferably of metal, such as aluminum, and consisting of two complemental rectangular sections l and 2. In use, these sections are detachably fastened together by interconnecting bolts 3, as seen best in Fig. l, and they respectively mount the well leg and injured leg equipment. The position vof these two sections is reversible in order toadapt the device to the treatment of right or left limb fractures, and a reversal is permitted by removal of the connecting bolts 3.

Considering first the parts associated with the uninjured limb, or what is referred to as the well leg equipment, as seen best in Figs. 6 and '7, a pair of U-shaped yokes 5 and are mounted in spaced relation on the base section i and a pair of rods i and 8 extend between and are mounted by the arms of theseyokes so that they extend lengthwise of the base member and in spaced relation for receiving the uninjured leg between them, as seen in Fig. 6. The yoke 6 preferably is wider than the yoke 5 and this causes a sort of divergence of the rods that better accommodates the rods to the form of the limb.

The rods 'l and 8 extend through and beyond the arms of the lower yoke 5 for the support of a foot rest 9 between them. This foot rest, as

seen in Figs. 6 and 7, is in the form of a shallow pan of suitable shape to rest the foot therein and, at opposite sides, it is provided with laterally extending apertured ears il), through which the rods 'l and 8 extend. The apertures of the ears are so shaped that the pan` may be easily adjusted on the rods to conform to any desired or necessary position of the foot and it may be retained at any set position of adjustment on the rods by lock nuts l i which are threaded onto the rods and adapted to be tightened against opposite sides of the ears l0.

Extending downwardly from the lower end of the foot rest 9 is a ieg l2 and a threaded bolt I3 extends through a vertically elongated aperture M in the lower end of the leg. At its inner e-nd the bolt is pivotally attached, as at l5, to the base portion of the yoke 5. Coiled springs l-.I are located about the bolt' at opposite sides of the leg l2 and are retained by nutsE l'l-ll" threaded onto the bolt. Adjustment of the nuts inwardly or outwardly may be made thereby to produce any desired tilting of the foot rest to raise or lower the foot and the springs permit of a certain desired yieldability for exercising the foot.

As seen in Fig. '7, the foot rest 9 may contain a suitable cushioning or padding element, as at I8, through which pressure may be applied against the foot without causing discomfort,

against the pan 9, straps or the like I9', also attached at their ends to the rods 'i and 8, are applied over the leg to prevent its being lifted from the support. The slings and straps may be 'adjustable and of any suitable material.

Each of the yokes 5 and 6 comprises upright, opposite side portions or arms and an arcuately curved base portion. The base portion is transversely serrated across the bottom surface. This bottom surface rests upon a base block 26 ythat is serrated on its top surface to conform to. the serrations of the yoke. The yoke 5 and the base block 2@ o1 the yoke, as seen in Figs. 2 and 3, are

connected throughthe medium of an attaching bolt 2i with a horizontal sleeve 22 that is disposed below the base i and which has a central shank 23 extending upwardly through a longitudinal slot in the base. The bolt 2l extends through the base portion of the yoke and supported in lugs 2l and 2'8 formed on the under side of the base. Suitable stops are formed on the shaft to retain it against longitudinal movement and it is provided at its outer end with a wing nut 29 by means of which it may be rotated. When the'shaft is rotated, the yoke 5 and parts attached thereto are bodily moved in the longitudinal direction' of the base.

The upper end yoke 6 likewise is mounted upon a serrated base block S and is adjustably attached thereto by a bolt 3i.

The block 3i] rests: freely upon the top surface of the base l and is n pivotally connected, as at 32, to the end of a link 33 which extends toward the yoke 5 in the longitudinal direction of the base and is attached pivotally to the base by a bolt 36 that extends through a longitudinal slot 35 in the link. The

provision of the slotted link 33 is to permit the upper end of the frame to be moved inwardly or outwardly in a lateral direction for the accomodation of persons of different size. In this movement of the leg support the lower yoke will pivot about the attaching bolt 2l. During any longitudinal adjustment of the support by means of the shaft 26, the link 33 will merely slide on the attaching bolt 34. Both the yokes 5 and 6 have slots 3l extending lengthwise of their base portions through which the attaching bolts 2i and 3l respectively extend. By loosening these bolts the yokes may be tilted to one side or the other to lbest accommodate the support to the limb, and they may then be heldin any position of adjustment by tightening the bolts to retain the serratedsurfaces of the yokes and their mounting blocks tightly-together.

With respect to the equipment for the support of the injured limb which is lmounted upon the or oscalcis of the injured limb. mounted between vertical spaced flanges 42--42' of a support 43 that is rotatably adjustable about a vertical axis upon a serrated base lug 44 cast upon the top surface of the base section 2.- This lug, is shown in detail in Fig. 5u. A'bolt 45 extends horizontally through the flanges of the mounting' member 43 and through an arcuate slot 46 in the base of the yoke and a wing nut 4'! is applied to the bolt for tightening the flanges against the yoke' base to hold it at different positions of adjustment. When the nut is loosened, the traction yoke may be tilted to different angular positions as providedv for by the slot 46, but the arrangement of parts is such that .the yoke merely rotates about the bone to which it is attached, as an axis. This prevents lateral movement of the limb. The mounting base 43 is also provided with a central mounting. shank 43' which extends downwardly' through a hole 48 centrally in the lug 44 and at its lower end the shank has a nut 49 threaded thereon which may be tightened to draw the parts 43 against the base 44 to retain it at any positionof rotative adjustment. When the nut 49 is loosened the member 43 may be rotated on its axis to turn the yoke 40 to different positions. To better retain an adjustment, the adjacent surfaces of the parts 43 and 44 are radially serrated to t together.

Mounted aboutthe lug 44 is a spider frame 50. This has a pair of spaced apart legs 5I and 5| directed upwardly and toward the upper end of the base. It also has a pair of spaced apart legs 52-52 directed upwardly and toward the lower end of the base portion. The legs 52-52' are provided with horizontal threaded extensions 53 which mount a foot platel 54 between them in a manner similar to the mounting of the foot rest 9 for the well leg. This foot plate 54 has laterally extending lugs 54 loosely receiving the extensions 53 and it is` provided with a downwardly extended leg 55 connected by means of a bolt 56 with the base of the spider. The bolt is pivotally attached to the spider, as at 5B and the lock nuts 51 are threaded onto the bolt and are adjustable thereon against the leg 55 to effect a desired tilting movement or adjustment of the foot plate for proper positioning of the foot. Also, by adjustment of retaining nuts 58 on the extensions 53 the rest may be adjusted to different angular positions transversely of the base or closer or farther from the yoke.

Cast on the upper end portion of the base member 2 is a serrated lug 66 similar to the lug 44, as shown in Fig. 5a, and mounted about this lug is a spider frame 6l similar in construction to the lower spider and provided with a pair of spaced legs 62-62 extended upwardly in the direction of the lower end of the base and provided also with a pair of spaced legs 63-63 extended horizontally beyond the upper end portion of the base. The legs Fal- 62 and 5I-62 of the two spiders support between them a pair of parallel rods 64 and 65. These are sufciently spaced to receive between them, as in Fig. 8, the injured limb of the person being treated. Suitable slings, as at 66, are attached adjustably to the rods for the support of the limb between them and also there are straps and slings 66a attached to the spider legs 63 to extend. both `tended into the base.

above andbelow the limb to retain its against upward or downward movement. The two spider frames 50 and 6| are adjustable on their supports and may be tilted laterally in either direction. Lateral tilting is provided for by arcuately` curving the base surfaces of the spiders transversely asseen in Fig. 4, and then providing .these .base portions with transverse slots as at l0 through which the lugs 44 extend and also with slots 'lathrough which anchor bolts 1| are ex- After a tilting adjustment of aspider has been made it may be retained in set position by tightening its anchor bolt ll. Thus, the support for the injured leg may be tilted to accommodate the individual requirements.

Assuming the' parts, as so far described, to be so constructed, use of the device for the reduction of a fracture would be as follows:

i .First, the base sections I and 2 are placed in proper position to accommodate a fracture of either the right or left limb. In Fig. 1 I have shown the device as applied for the reduction of a fracture of the femur of the left leg. If the fracture was in the right leg, the position of the base section would be reversed. For this reduction, the uninjured limb is placed with the foot placed against the foot rest 9, and the leg supports or slings YI9 are adjusted to properly suspend the limb to prevent it from moving relative to the support. The foot rest 9 should be properly adjusted to accommodate'the position or prevent discomfort to the patient incident to the pressure that is exerted against it. Then the injured limb is prepared for reception of the pin 4l, or wire, which is projected through the lower end portion of the tibia or heel bone. After the pin, or wire, has been applied, the limb is then positioned for clamping the ends of the pin or wire within the upper end portions of the arms of the yoke 40. After the wire or pin is properly fastened at its ends in the yoke, the foot rest 54 is adjusted to properly support the foot against drop. Then the slings 66 are properly adjusted for support of the limb thereon between the rods and across the spider frames. If necessary, or desirable, a plaster cast may be applied about the lower yoke and pin to prevent movement of the limb that might result in damage to the flesh at the point where the pin or wire passes through.

the supporting equipment for the well leg upf wardly along `thefbase mounting relative to the injured limb, a tractive force will be exerted on the lower fragment of the injured limb and this may be made sufficient to properly reduce the fracture; it being understood that the injured limb is not movable.

While I have not so illustrated it, it is possible to apply Newton tongs to the yoke to eiect a connection with the bone in lieu of using the pin or wire.

It is apparent that the adjustability of the equipment, especially with respect to the movement of the yokes, foot rests, spiders, and slings, makes it possible to adapt the equipment to different types of fractures and to persons of different size. A large person naturally requires diierent adjustments than are required for a small person, and these different requirements are amply provided for.

With reference to the traction yoke 40 and parts associated therewith, it is possible to use a rod or wire 4| through the bone Then in order to make it possible to easily attach this wire or rod to the yoke ends, and to tighten the wire when this is used, I have provided one arm of the yoke with a clamping plate 'I5 held by a bolt 76. The end of the arm has a knurled surface 18 and a transverse U-shaped groove 18' over which the plate may be clamped. In the use of a pin, one end is seated in the groove. If a wire is used, the end is placed against the knurled surface. Then the clamping plate 'I5 is placed thereon and drawn down by tightening the bolt 16.

The other end of the rod, or wire 4|, is extended through a hole 80 in a block 8|, as seen in Fig. 5, and also through a hole 82 in the shank of the bolt 83 that is projected upwardly through a hole 84 in the block. Then a nut 85 on the bolt is tightened to draw the bolt head 83' tightly against the wire or pin to grip and secure it in the block.

This block is slidable lengthwise in a seat 90 A in the yoke arm, and at its outer end it has a threaded shank 9| to which a nut 92 is applied. The nut seats against a Washer 93 applied about the shank and against the side face of the yoke arm. When the nut is tightened, this draws the block outwardly and places the wire or pin under tension. The washer, as seen in Fig. 5, has upper and lower back turned flanges 94-94 respectively overlying the block and underlying the seat in which it rests to prevent any possible upward displacement of the block from the seat. Also, at the inner end of the block is a pin 95 which, at its ends, is movable in slots 96in the side walls of the seat, as an additional protection against the block being unseated. Removal of the nut 92 and the clamp plate permits easy disassembly of the parts.

In the event that it should be more desirable to apply the traction pin, or wire, 4| through the femur at a point above the knee, this would be possible by removing the yoke 40 from the position shown in Fig. 9 and applying it to a base member 43a that is applied to the lug 6B. It Will be observed that the part 43a is of the same construction as the previously described part 43 and that its location is such that the traction yoke and wire may be applied to the femur at the above mentioned position as seen in dotted lines in Fig. 9

In Figs. l and 11 I have shown the base sections and 2 equipped with an extension frame serving as a body support to aid in moving the patient while the fracture reducing means is in place. This frame consists of parallel, opposite .eide rods 0|) and 6| joined across the upper ends by cross rod H32 and having their lower end portions somewhat inset and removably applied to socket members |04 that are detachably applied to the cuter sides of the base sections. The detailed View of Fig. 14 illustrates the application of the socket members and the manner of attaching them to permit of ready removal in the event that it is desired to reverse the sections. This tubular frame member is suiiiciently large to surround the body portion of the patient, as in Fig. l0, and there are detachable straps |05 stretched between the side bars upon which the patient may rest. When it is desired to move or raise the patient, the frame and base are bodily lifted. Holes |07 are provided in the corners of the base members, as seen in Fig. 10, to V-receive pulley attachments as an aid in the lifting.

In view of the fact that the use of this fracture reducing equipment throws the transverse line of the' pelvis bones in an angular position relative to normal, and thus the line of the spine will be deformed, unless the patients body position is shifted accordingly, it is preferred that the frame structure be arranged either by the provision of special joints on the bars |00 and |il| or by special formation to extend angularly relative to the normal line in accordance with the change in alinement of the pelvis bones. That 1s, the direction of the frame should be at right angles to the transverse line of the pelvis bones. Such an angular arrangement of theframe is indicated in dotted lines in Fig. 10.

In order that this frame may also serve as a support to aid the patient in sitting up, the side bars are jointed as at |08. The joint is in line with the hip joints of the patient and are so arranged that the frame may be lifted upwardly as to the dotted line position in Fig. 11.

In order that the orthopedic frame may be held rigid for normal use, or for moving the patient, I have provided tubular sleeves Il!) adapted to be slipped down over the joints so as to render the parts rigid. These sleeves, as seen in Fig. 12, are in the form of T fittings for a purpose presently described.

Figs, l0 and l1 also illustrate the application of removable supports to the frame upon which the patient may be placed for manipulation, reductions, operations, or for any special treatment such as for the application of body casts. One of these supports comprises a cross rod ||5 adapted to be applied at its ends to the T fittings H0. This cross rod mounts a saddle H6, upon which the patient may be placed. There is also a support |26 for the shoulders and head of the patient. This is in the form of a rectangular frame with leg portions |2| adapted to rest upon the opposite side bars. It is to be understood that various forms of supports may be constructed for special uses.

For temporary use I have illustrated in Fig. 11 a foot plate |25 to which the foot of the injured limb may be attached by means of bandages, or the'like. This foot plate is adapted to project at its lower end into slot |26 provided in the base member, thus to hold the plate upright and rigid.

The plate is centrally jointed as at |21 to permit of a internal or external rotation, and adjustment is held by a bolt and wing nut |28. With the plate of this character it is possible to easily move the patient without discomfort to the patient and without causing any displacement of the fracture reducing mechanism. Such devices may be varied somewhat in size but it is intended that the adjustability of the leg equipment be such that one size will take care of all patients.

While I have illustrated the bases and 2 fixed together and reduction of the fracture accomplished by movement of the Well leg equipment relative to the injured leg, it is to be understood that the same results might likewise be obtained by making the well leg equipment `stationary on the base and pulling down on the injured leg through its equipment which would in this instance be mounted for adjustment.

Also, it is readily apparent that the leg equipment on each base could be xed thereon, and the reduction of the fracture effected by relative movement of the two bases. Such movement of the bases could be effected by means as illustrated in Fig. 15 wherein base I has a lateral arm |30 fixed to one end thereof rigidly mounting a threaded shaft I3I whichaextends lengthwise of the base 2 in suitable guides |32 and mounts a nut |33 that may be adjusted to effect an adjustment of the bases in an endwise direction.

Various other devices such as turnbuckle levers, hydraulic cylinders or the like might likewise be applied to effect the adjustment.

In another instance it might be more desirable to have the bases` secured together and the equipment of both legs adjustable thereon through the medium of levers,` screws, or the like so that movement of one is coincident with an opposite movement of the other,

Having thus described my invention, what I claim as new therein and desire to secure by Letters Patent is- 1. A device of the character described comprising a base, a frame structure secured on the base for mounting the well leg therein, said frame comprising spaced apart bars, leg supporting and retaining meansextended between the bars and a foot rest adjustable along the bars to sustain pressure of the lfoot thereagainst, a frame structure secured on the base for mounting the injured leg therein and comprising a pair of spaced bars, leg supports and retaining means extended between the bars, a yoke at the lower end of the frame and a pin, fixed therein for skeletal attachment of the leg to the base; said Well leg frame being adjustable on the base in a lengthwise direction.

2. In a splint, a base, a well leg support comprising spaced apart yokes adjustably xed on the base, a pair of bars supported by the arms of'said yokes in spaced relation to receive the leg between them, straps extended between the bars to rest the leg thereon, means extended between the bars to overlie the leg,afoot rest adjustable along the bars and adapted to be tilted to different positions of 40 inclination, blocks secured to the base for mounting the yckes, and said yokes having arcuately curved base portions fitted on the mounting block and adjustable therealong for tilting the frame to different positions.

3. In a device of the character described, a base section, a well leg supporting frame mounted thereon and comprising spaced apart yokes, a pair of bars supported by the arms on the yokes in spaced relation to receive the leg between them, leg supporting and retaining means extended between the bars, a foot rest adjustable along the bars, means for tilting the foot rest to diierent positions, a threaded shaft rotatably mounted in the base member, a nut threaded on the shaft and connected with the frame and means for rotating the shaft to shift the frame lengthwise on the base.

4. In a splint of the character described, a at, horizontal base adapted to underlie both limbs of the user as a leveling support, two longitudinal frame structures adjustably mounted on the base, each for cradling oneof the limbs therein, means fixed on the base for effecting a skeletal connection with the injured limb; said means being independent of the corresponding frame structure and adapted to sustain tractive force for the reduction of a fracture in the limb; the opposite frame structure including means for effecting an endwise movement thereof to cause an application of countertractive force to be applied to the limb supported thereby for effecting extension of the opposite limb.

5. A device as recited in claim 3, wherein the countertraction frame is rotatably adjustable on the base and includes an adjustable foot piece against which the foot of the limbv applied ther to bears to sustain the countertractive force, and including means for adjusting the angular position of the foot piece relative to the direction of applied force.

ROGER ANDERSON. 

